Avaliação da Congestão Venosa por Ultrassonografia Point-of-Care: Estado da Arte

Autores

DOI:

https://doi.org/10.24950/rspmi.1966

Palavras-chave:

Hiperemia, Pressão Venosa Central, Sistemas Automatizados de Assistência Junto ao Leito, Ultrassonografia, Veias

Resumo

A avaliação da congestão venosa apresenta-se como um
dos maiores desafios médicos da atualidade: desde técnicas mais invasivas até ao surgimento da avaliação ecográfica, a investigação tem sido constante, na expectativa de otimizar e melhorar a monitorização hemodinâmica dos doentes, através de exames à cabeceira do doente mais céleres e menos invasivos.

A hipertensão venosa é um importante mecanismo fisiopatológico na congestão venosa e consequente lesão de órgão, mas o seu diagnóstico é desafiante apenas pelo exame objetivo tradicional. Desta forma, a capacidade da ecografia point-of-care (POCUS) de caracterizar a anatomia e a fisiologia emtempo real, bem como de analisar fluxos dinâmicos, torna-a numa ferramenta importante e de maior sensibilidade no diagnóstico e monitorização da congestão venosa.

Neste artigo os autores fazem um breve resumo da fisiopatologia inerente, bem como da avaliação sistematizada da congestão venosa sistémica através de POCUS.

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Referências

Galindo P, Gasca C, Argaiz ER, Koratala A. Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment. World J Crit Care Med. 2021;10:310-22. doi: 10.5492/wjccm.v10.i6.310.

Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014;40:1795-815. doi: 10.1007/s00134-014-3525-z.

Soliman-Aboumarie H, Denault AY. How to assess systemic venous congestion with point of care ultrasound. Eur Heart J Cardiovasc Imaging. 2023;24:177-80. doi: 10.1093/ehjci/jeac239.

Deschamps J, Denault A, Galarza L, Rola P, Ledoux-Hutchinson L, Huard K, et al. Venous Doppler to Assess Congestion: A Comprehensive Review of Current Evidence and Nomenclature. Ultrasound Med Biol. 2023;49:3-17. doi: 10.1016/j.ultrasmedbio.2022.07.011.

Koratala A, Kazory A. Point of Care Ultrasonography for Objective Assessment of Heart Failure: Integration of Cardiac, Vascular, and Extravascular Determinants of Volume Status. Cardiorenal Med. 2021;11:5-17. doi: 10.1159/000510732.

Verbrugge FH, Guazzi M, Testani JM, Borlaug BA. Altered Hemodynamics and End-Organ Damage in Heart Failure: Impact on the Lung and Kidney. Circulation. 2020;142:998-1012. doi: 10.1161/CIRCULATIONAHA.119.045409.

Verbrugge FH, Dupont M, Steels P, Grieten L, Malbrain M, Tang WH, et al. Abdominal contributions to cardiorenal dysfunction in congestive heart failure. J Am Coll Cardiol. 2013;62:485-95. doi: 10.1016/j.jacc.2013.04.070

Schroedter WB, White JM, Garcia AR, Ellis ME. Presence of Lower-Extremity Venous Pulsatility is not always the Result of Cardiac Dysfunction. J VascUltrasound. 2014;38:71-5. doi:10.1177/154431671403800201- 75.

Tang WH, Kitai T. Intrarenal Venous Flow: A window into the congestive kidney failure phenotype of heart failure? JACC Heart Fail. 2016;4:683-6. doi: 10.1016/j.jchf.2016.05.009.

Mesin L, Albani S, Sinagra G. Non-invasive estimation of right atrial pressure using inferior vena cava echography. Ultrasound Med Biol. 2019;45:1331-7. doi: 10.1016/j.ultrasmedbio.2018.12.013.

Kircher BJ, Himelman RB, Schiller NB. Noninvasive estimation of right atrial pressure from the inspiratory collapse of the inferior vena cava. Am J Cardiol. 1990;66:493-6. doi: 10.1016/0002-9149(90)90711-9.

Blehar DJ, Resop D, Chin B, Dayno M, Gaspari R. Inferior vena cava displacement during respirophasic ultrasound imaging. Crit Ultrasound J. 2012;4:18. doi: 10.1186/2036-7902-4-18.

Furtado S, Reis L. Inferior vena cava evaluation in fluid therapy decision making in intensive care: practical implications. Rev Bras Terap Intensiva. 2019;31:240-7. doi: 10.5935/0103-507X.20190039.

González Delgado DA, Romero González GA. Valoración ultrasonografica de la congestión venosa: VExUS una herramienta de medicina de precisión a pie de cama. Rev Ecocar Pract. 2021;4:52-4.

Gallix BP, Taourel P, Dauzat M, Bruel JM, Lafortune M. Flow pulsatility in the portal venous system: a study of Doppler sonography in healthy adults. AJR Am J Roentgenol. 1997;169:141-4. doi: 10.2214/ajr.169.1.9207514.

Denault AY, Beaubien-Souligny W, Elmi-Sarabi M, Eljaiek R, El-Hamamsy I, Lamarche Y, et al. Clinical Significance of Portal Hypertension Diagnosed With Bedside Ultrasound After Cardiac Surgery. Anesth Analg. 2017;124:1109-15. doi: 10.1213/ANE.0000000000001812.

Ikeda Y, Ishii S, Yazaki M, Fujita T, Iida Y, Kaida T, et al. Portal congestion and intestinal edema in hospitalized patients with heart failure. Heart Vessels. 2018;33:740-51. doi: 10.1007/s00380-018-1117-5.

Bouabdallaoui N, Beaubien-Souligny W, Oussaïd E, Henri C, Racine N, Denault AY, et al. Assessing Splanchnic Compartment Using Portal Venous Doppler and Impact of Adding It to the EVEREST Score for Risk Assessment in Heart Failure. CJC Open. 2020;2:311-20. doi: 10.1016/j.cjco.2020.03.012.

Bouabdallaoui N, Beaubien-Souligny W, Denault AY, Rouleau JL. Impacts of right ventricular function and venous congestion on renal response during depletion in acute heart failure. ESC Heart Fail. 2020;7:1723-34. doi: 10.1002/ehf2.12732.

Romero-González G, Manriquea J, Castaño-Bilbaoa I, Slon-Robleroa F, Ronco C. PoCUS: Congestión y ultrasonido dos retos para la nefrología de la próxima década. Nefrologia. 2022;42:501-620.

de la Espriella-Juan R, Núñez E, Miñana G, Sanchis J, Bayés-Genís A, González J, et al. Intrarenal venous flow in cardiorenal syndrome: a shining light into the darkness. ESC Heart Fail. 2018;5:1173-5. doi: 10.1002/ehf2.12362.

Abhilash K. Venous congestion assessment using point-of-care Doppler ultrasound: Welcome to the future of volume status assessment. Clin Case Rep.2021; 9;1805 - 07.

Mahmud S, Koratala A. Assessment of venous congestion by Doppler ultrasound: a valuable bedside diagnostic tool for the new-age nephrologist. CEN Case Rep. 2021;10:153-5. doi: 10.1007/s13730-020-00514-5.

Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, Denault AY. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J. 2020;12:16. doi: 10.1186/s13089-020-00163-w.

Tung-Chen Y, García de Casasola-Sánchez G, Méndez-Bailón M. Medición de la congestión venosa empleando la ecografía: protocolo VExUS. Galicia Clin. 2022; 83: 32-7.

Steven C. Unvexing the vexus score: am overview, PoCUS Clinical Pearl. DalEM PoCUS Elective. PGY2 Internal Medicine University of Toronto. Toronto: UT; 2018.

Torres-Arrese M, Mata-Martínez A, Luordo-Tedesco D, García-Casasola G, Alonso-González R, Montero-Hernández E, et al. Usefulness of Systemic Venous Ultrasound Protocols in the Prognosis of Heart Failure Patients: Results from a Prospective Multicentric Study. J Clin Med. 2018;12:1281. doi: 10.3390/jcm12041281

Torres-Arrese M, Mata-Martínez A, Luordo-Tedesco D, García-Casasola G, Alonso-González R, Montero-Hernández E, et al. Usefulness of systemic venous ultrasound protocols in the prognosis of heart failure patients: results from a prospective multicentric study. J Clin Med. 2023;12:1281. doi: 10.3390/jcm12041281.

Istrail L, Kiernan J, Stepanova M. A novel method for estimating right atrial pressure with point-of-care ultrasound. J Am Soc Echocardiogr. 2023;36:278-83. doi: 10.1016/j.echo.2022.12.008.

Simon MA, Schnatz RG, Romeo JD, Pacella JJ. Bedside ultrasound assessment of jugular venous compliance as a potential point-of-care method to predict acute decompensated heart failure 30-day readmission. J Am Heart Assoc. 2018;7:e008184. doi: 10.1161/JAHA.117.008184.

Istrail L, Stepanova M. Novel point-of-care ultrasound (POCUS) technique to modernize the JVP exam and rule out elevated right atrial pressures. medRxiv 2021.10.14.21264891. doi: 10.1101/2021.10.14.21264891

Torres-Arrese M, Mata-Martínez A, Luordo-Tedesco D, García-Casasola-ánchez G, Montero-Hernández E, Cobo-Marcos M, et al. Papel del Doppler de la vena femoral en pacientes con insuficiencia cardiaca aguda: resultados de un estudio multicéntrico prospectivo, Rev Clín Esp. 2023 (in press). doi: 10.1016/j.rce.2023.03.002.

Calderone A, Hammoud A, Jarry S, Denault A, Couture EJ. femoral vein pulsatility: what does it mean? J Cardiothorac Vasc Anesth. 2021;35:2521-7. doi: 10.1053/j.jvca.2021.03.027.

Bhardwaj V, Rola P, Denault A, Vikneswaran G, Spiegel R. Femoral vein pulsatility: a simple tool for venous congestion assessment. Ultrasound J. 2023;15:24. doi: 10.1186/s13089-023-00321-w.

Finnerty NM, Panchal AR, Boulger C, Vira A, Bischof JJ, Amick C, et al. Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode? West J Emerg Med. 2017;18:496-501. doi: 10.5811/westjem.2016.12.32489.

Huguet R, Fard D, d'Humieres T, Brault-Meslin O, Faivre L, Nahory L, et al. Three-Dimensional Inferior Vena Cava for Assessing Central Venous Pressure in Patients with Cardiogenic Shock. J Am Soc Echocardiogr. 2018;31:1034-43. doi: 10.1016/j.echo.2018.04.003.

Seo Y, Iida N, Yamamoto M, Machino-Ohtsuka T, Ishizu T, Aonuma K. Estimation of Central Venous Pressure Using the Ratio of Short to Long Diameter from Cross-Sectional Images of the Inferior Vena Cava. J Am Soc Echocardiogr. 2017;30:461-7. doi: 10.1016/j.echo.2016.12.002.

Romero-González G, Manrique J, Castaño-Bilbao I, Slon-Roblero MF, Ronco C. PoCUS: Congestion and ultrasound two challenges for nephrology in the next decade. Nefrologia. 2022;42:501-5. doi: 10.1016/j.nefroe.2021.09.008.

Beaubien-Souligny W, Denault AY. Real-Time Assessment of Renal Venous Flow by Transesophageal Echography During Cardiac Surgery. A A Pract. 2019;12:30-2. doi: 10.1213/XAA.0000000000000841.

Publicado

29-06-2023

Como Citar

1.
Vazquez D, Arroja S, Guerreiro Cruz S, Fernandes Santos I, Tung Chen Y. Avaliação da Congestão Venosa por Ultrassonografia Point-of-Care: Estado da Arte. RPMI [Internet]. 29 de Junho de 2023 [citado 22 de Julho de 2024];30(2):114-21. Disponível em: https://revista.spmi.pt/index.php/rpmi/article/view/1966

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